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Senior Claims Analyst

Senior Claims Analyst

TriWest Healthcare AlliancePhoenix, AZ
12 days ago
Job type
  • Full-time
Job description

Job Summary

Performs research to assess root cause of moderate to high complexity claims issues and escalations. Conducts root cause and impact analyses as needed. Logs claims issues and tracks status and activities to ensure timely End-to-End (E2E) issue resolution. Regularly engages with the claims subcontractor and internal business partners to provide and receive status updates, obtain required data, and confirm resolution. Evaluates claims data and trend reports regularly to proactively identify provider billing issues, system issues, and / or improvement opportunities.

Education & Experience

Required :

  • High School diploma or GED
  • 5 years of healthcare claims, billing (or related healthcare area) experience
  • 1 year of experience performing claims-related research
  • Intermediate proficiency with MS Office suite, with an emphasis on Excel
  • Knowledgeable of claims processing and medical management systems

Preferred :

  • Bachelor's (BS / BA) Degree in healthcare or related field, or equivalent experience
  • 1 to 2 years conducting claims-related data analysis
  • 2 years of Government claims experience
  • Quality or Process Improvement experience
  • Knowledgeable of Root Cause Analysis concepts and methodologies
  • Experience with Facets and / or CareRadius systems

    • Key Responsibilities

  • Serves as subject matter expert resource to department and internal business partners
  • Communicates issues and status updates to Manager and all appropriate stakeholders
  • Partners with claims subcontractor, department management and peer team, and / or internal business partners on process improvements and issue resolution
  • Conducts moderate to high complexity claims research, including root cause and impact analysis
  • Logs and monitors issues E2E, following up on related activities in an appropriate and timely manner
  • Communicates appropriately and effectively, using verbal and written channels
  • Performs other duties as assigned
  • Regular and reliable attendance required

    • Competencies

    Communication / People Skills : Ability to influence or persuade others under positive or negative circumstances; Adapt to different styles; Listen critically; Collaborate.

    Computer Literacy : Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.

    Coping / Flexibility : Resiliency in adapting to a variety of situations and individuals while maintaining a sense of purpose and mature problem-solving approach

    Information Management : Ability to manage large amounts of complex information easily, communicate it clearly, and draw sound conclusions

    High Intensity Environment : Ability to function in a fast-paced environment with multiple activities occurring simultaneously while maintaining focus and control of workflow

    Organizational Skills : Ability to organize people or tasks, adjust to priorities, learn systems, within time constraints and with available resources; Detail-oriented.

    Problem Solving / Analysis : Ability to solve problems through systematic analysis of processes with sound judgment. Has a realistic understanding of relevant issues

    Team-Building / Team Player : Influence the actions and opinions of others in a positive direction and build group commitment

    Technical Skills : Advanced analytical skills. Knowledge of fundamentals of accounting and sound business processes. Extensive Knowledge of Microsoft Excel; proficient with Word; process diagram and documentation experience preferred. Research and project management skills

    Working Conditions

    Working Conditions :

  • Favorable working conditions in a climate controlled office space
  • Ability to stand and speak for long periods of time
  • Must be available for to cover any work shift
  • Works within an office environment with some travel required
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    Senior Analyst • Phoenix, AZ